Preventive Medicine & Wellness Care

“Angina is not a disease in and of itself; instead, it serves as a warning that an area of the heart is not getting enough oxygen. Angina should never be ignored- you should take it as the warning that it is and seek medical care if you experience chest pain or discomfort.”

-Dr. Bella Zimilevich, MD

What is angina?

Angina is chest pain or discomfort that occurs when a portion of the heart does not receive enough oxygen-rich blood. It usually occurs due to coronary artery disease (CAD). If you have CAD, an artery (or more than one artery) becomes partially blocked with plaque, a waxy substance that can occlude arteries and block blood flow. High cholesterol can influence plaque formation, and high blood pressure can damage arteries, making them stiffer and less pliable, and thus less able to allow blood to flow freely. When plaque builds up, a clot can form, which can increase your risk of having a myocardial infarction (heart attack) if a clot happens to occlude an artery, completely blocking the flow of blood in the affected artery.

What are the types of angina?

Angina can take more than one form. It is important to determine which type of angina you have, as treatment may vary:

• Stable angina– this is the most common type. In stable angina, the heart must work harder than normal to do its job, and anything that increases the workload of the heart may cause pain. In stable angina, you can usually predict what activities will provoke pain. The pain subsides when you rest or take your medication. Stable angina is a warning that a heart attack may occur in the future.
• Unstable angina– unstable angina occurs not only during activity, but also at rest. Unstable angina is unpredictable and may not stop when you rest or take medication. Unstable angina is a warning that a heart attack may be imminent and should be taken very seriously.
• Variant angina– this type of angina occurs when a coronary artery goes into spasm. It is very painful and often occurs in the middle of the night. It can often be controlled with medication.

Is all chest pain caused by angina?

No. Chest pain can be caused by many other conditions other than angina. This is why it is so important to see a doctor if you are experiencing chest pain.

Chest pain can be caused by musculoskeletal injury to the chest wall, pulmonary embolism, pneumonia and other conditions, some of which may be very serious and some, like musculoskeletal injury, that are painful but not life-threatening.

What can I expect when I come and see you?

If you come in and see me with chest pain, I will ask about your past medical history, medications you are taking and any allergies you might have. I will also ask about your family history of heart disease.

I will examine you, paying close attention to your heart and lungs. I will order an ECG, which records the electrical activity of your heart and can tell me if you have an abnormal rhythm or if you have ECG changes that indicate your heart is not getting enough oxygen (“ischemic changes”). I will also check your blood pressure and other vital signs. I may order blood tests, depending on what I think the cause of your chest pain might be. Blood tests might include a complete blood count, cholesterol testing and other tests that will provide me with information regarding your general health status. I may also order a stress test, which measures how well your heart functions under “stress” (exercise).

If need be, I may refer you to a cardiologist if I feel you need to see a specialist. I can work with your specialist and you to ensure that your care needs are being met.

If you have angina or chest pain, don’t wait to come in to be seen. Chest pain should always be assessed by a medical professional to rule out cardiac disease or other serious conditions. If you have chest pain, don’t delay- make an appointment today.

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